Nutrition and Aging Drug Interaction

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Final 5/2/13

What is drug-nutrient interaction?

the result of the action between a drug and a nutrient that would not happen with the nutrient or the drug alone

What is food-drug interaction?

a broad term that includes drug-nutrient interactions and the effect of a medication on nutritional status

True or False
Elderly more vulnerable to drug-nutrient interactions

False

There is a direct correlation between the _____ and number of _____

Direct correlation between the age and the number of prescriptions

25 - 50% of adverse drug reactions in older adults may be ________

preventable

What is poly-pharmacy?

Taking multiple unnecessary medications

What are the four most common categories of drugs the elderly take?

antihypertensive, analgesic-antipyretics, antirheumatics, anticoagulants

What are the main disorders the elderly get?

•Cardiovascular disease
•Arthritis
•Antihypertensives
•Gastrointestinal disorders
•Bladder dysfunction

If you take prescription drugs and answer yes to 7 questions, you could be at increased risk for polypharmacy. What are the 7 questions?

1.Do you take herbs, vitamins or OTC products?
2.Do you have to take medicine more than once a day?
3.Do you suffer from arthritis?
4.Do you use different pharmacies to fill prescriptions?
5.Do you have poor eyesight or hearing?
6.Do you live alone?
7.Do you sometimes forget to take your medication?

What is Pharmacokinetics?

a branch of pharmacology dedicated to the determination of the fate of substances administered externally to a living organism.

What are the top 5 most commonly used medications in men age 65 and older?

Aspirin (39%)
Acetaminophen (16%)
Furosemide (12%)
Digoxin (9%)
Warfarin sodium (8%)

What are the top 5 most commonly used medications in men age 65 and older?

Acetaminophen (27%)
Aspirin (23%)
Conjugated estrogens (17%)
Ethinyl estradiol (13%)
Hydrochlorothiazide (12%)

What medications are used to manage hypertension and what is the reasoning behind it?

diuretics, beta-blocker bc Depletion of minerals (Potassium, Ca, Mg)
Constipation

What medication is used to manage CHD? What is the nutritional implication to why this is used?

Digitalis, Anorexia and /or nausea

10% elderly do not know ____ of medication

purpose

When the elderly are hospitalized, _____patients use ______

On admission, two medications

When the elderly are hospitalized, when they're ____hospital: prescribed __________.

In hospital: prescribed 6 medications (antibiotics, analgesic, diuretic, sedative, K salts, digoxin, antacid)

What is PRN?

(pro re nata- as needed

What drugs are prescribed as neede?

sedatives,
hypnotics,
analgesics,
laxatives

What are some drug side effects that affect nutritional status?

•Appetite changes
•Oral taste and smell
•Nausea
•Dry mouth
•Gastrointestinal effects
•Organ system toxicity
•Glucose levels

Movement of drugs through the body by

•Absorption
•Distribution
•Metabolism
•Excretion

What does movement of the drug from the site of administration to the bloodstream; depend on?

The route of administration
The chemistry of the drug and its ability to cross membranes
The rate of gastric emptying (for oral drugs) and GI movement

True or False
Food, food components and nutritional supplements do not interfere with absorption, especially if the drug is taken orally

FALSE
Food, food components and nutritional supplements CAN interfere with absorption, especially if the drug is taken orally

Drugs in the bloodstream are often bound to _______

plasma protein

only ______drugs can leave the blood and affect target organs

unbound drugs

_________ can increase availability of drugs and potentiate their effects

Low serum albumin

Where does metabolism that change fat soluble compounds to water soluble occur?

liver

What enzyme facilitates drug metabolism?

cytochrome P-450

Foods or dietary supplements that increase or inhibit cytochrome p-450 enzyme systems can _______

change the rate or extent of drug metabolism

______ are eliminated from the body as an unchanged drug or metabolite

Drugs

What is warfarin? What should it not be taken with?

is an anticoagulant normally used in the prevention of thrombosis and thromboembolism, the formation of blood clots in the blood vessels and their migration elsewhere in the body respectively. Sould not be taken with vitamin K.

__________is the major route of elimination; affected by renal function and urinary pH

renal excretion

Some drugs are eliminated in ____and other body fluids

bile

What are mechanisms of drug-nutrient actions?

1.Interference with normal process (Ingestion and absorption)
2.Depletion of nutrient reserves
3.Effects of drug-receptor interaction
4.Effects of Over-the-Counter (OTC) Drugs
5.Effects of foods on drug
6.Use and abuse of vitamin, mineral supplements
7.Alcohol addition
8.Abuse of drugs

What are antineoplastic drugs?

drugs that inhibit or prevent the growth and spread of tumors or malignant cells

What is an anorectic effect?

loss of appetite

When ingesting _____ and ____ drugs, a side effect is loss of appetite (anorectic)

antineoplastic and cardiac drugs

Ingesting antineoplastic and cardiac drugs can cause a loss of appetite (anorectic effect) ___acuity decreases as well as _____

taste and smell

Drugs with lithium can cause _____

THIRST

What is a psychotrophic drug?

is a chemical substance that crosses the blood-brain barrier and acts primarily upon the central nervous system where it affects brain function, resulting in alterations in perception, mood, consciousness, cognition, and behavior.

Due to gastric pH_____ and HCL_____, absorption may decline

pH increase and HCL decrease

What drugs decrease motility?

anticholinergic drugs

____ change GI pH, & can cause thiamin deficiency

antacids

Antibiotics can influence _____

microflora (bacteria from other organisms)

Tetracycline binds ______ and _____ it _____ absorption

binds to Ca and Mg it DECREASES absorption

50 % Absorption of iron from supplements______

50% decrease when taken with food

____is best absorbed when taken with 8 oz of water on empty stomach

iron supplements

If you take iron supplements, avoid foods such as

bran, eggs, fiber supplements, tea, coffee, dairy products, calcium supplements

True or False
Presence of food enhances the absorption of some medications

True

True or False
All drugs damage intestinal mucosa destroying microvilli and villi (e.g. colchicines for gout)

False
some drugs damage intestinal mucosa destroying microvilli and villi (e.g. colchicines for gout)

Drug distribution : Affected by changes in body composition. Fat, LBM and body water affects drug distribution. Which one has a more effective distribution?

Fat.

_____ are vitamin K antagonist

warfarin

_____ depresses folate metabolism

methotextrate *commonly used to terminate pregnancies

____ decreses hydroxylation of vitamin D

isoniazid

_____ is an anticoagulant that prevents the conversion of vitamin K to a usable form

warfarin

What are other foods with anticlotting qualities

garlic, onions, vitamin E in large amounts, and ginseng

______can make drugs more potent by increasing availability to tissues

low albumin levels ( a family of globular proteins) can result in poor hemmorrhage

_______ or ______persons have a higher ratio of adipose tissue; fat soluble drugs may accumulate in the body ↑ risk of toxicity

obese, elderly

Metabolism Liver metabolism decrease due to:

decrease blood flow, decrease hepatic mass

Excretion Glomerular filtration & renal blood flow _____

decrease

Patients on low______diets will reabsorb more lithium along with _____

sodium, sodium

patients on high _____diets will excrete more lithium and need higher doses

sodium

Some extreme diets may affect _______pH which affects _____

urinary pH, affects resorption of acidic and basic medications

Drug use over extended period of time can

deplete nutrient reserves

Name some drugs that effect drug receptor interactions

•Diuretics
•Antihypertensives
•Cardiac drugs
•Drugs to manage diabetes
•Analgesics

Some receptor sites for drugs on cells increase in sensitivity with

age (increase drug uptake)

Decreased receptor sensitivity may also

occur leading to need for more drug for Rx effect

What are the side effects of laxatives?

chronic diarrhea, leading to sodium, potassium imbalance and cause heart rhythm irregularities.

What are the side effects of antihistamines?

confusion

What are the side effects of cold medications?

increase blood pressure and lead to strokes

What are the side effects of caffeine?

anxiety and insomnia

Foods alter

Rate of gastric emptying
Rate of dissolution of the drug

_____can interfere with trace elements

calcium

Folate can mask a _____ deficiency

B 12

Mega doses of ____ and ____ supplements may be dangerous

vitamin and mineral supplements

What is the 12th leading cause of death in the U.S.(1999)

Chronic Liver Disease and Cirrhosis

What factors increase the use of alcohol?

Physical and emotional distress
Loneliness
Bereavement
Tolerance to alcohol decreases with age

_____ interacts with drugs

alcohol

_____exacerbates several diseases

alcohol

True or false
Half of elderly alcoholics are early onset drinkers and one-third are late onset (after age 60)

False
Two-thirds of elderly alcoholics are early onset drinkers and one-third are late onset (after age 60)

Why are elderly people less tolerant to alcohol?

Alcohol has a higher absorption rate in the elderly, causing a greater degree of intoxication

Elderly people are less tolerant to alcohol. One reason is because of a fall in ratio of ______ to _____

A fall in ratio of body wat

Alcohol decreases _____blood flow

hepatic-liver will receive more damage

Elderly people don't have efficient ____enzymes therefore alcohol will not be broken down as efficiently

liver

What are some indications of alcohol or medication related problems?

•Memory trouble after having a drink or taking a medication
•Loss of coordination ( walking unsteadily, frequent falls)
•Changes in sleeping habits
•Unexplained bruises
•Being unsure of oneself
•Irritability, sadness, depression
•Unexplained chronic pain
•Changes in eating habits
•Wanting to stay alone much of the time
•Failing to bathe or keep clean
•Having trouble concentrating
•Difficulty staying in touch with family or friends
•Lack of interest in usual activities

_______ inhibits metabolism of many drugs

grapefruit

What does grapefruit inactivate?

Inactivates metabolizing intestinal enzyme resulting in enhanced activity and possible toxicity

Effect persists for ____ hours so it is not helpful to separate the drug and the grapefruit

72

What are some drugs known to interact with grapefruit juice?

anti-hypertensives, immunosuppressants, antihistamines, protease inhibitors , lipid-lowering drugs, anti anxiety, anti depressants

What are some benefits of minimizing food drug interactions?

•Medications achieve their intended effects
•Improved compliance with medications
•Less need for additional medication or higher dosages
•Fewer caloric or nutrient supplements are required
•Adverse side effects are avoided
•Optimal nutritional status is preserved
•Disease complications are minimized

When medications are initiated, patients should be provided with complete written and verbal ________at an appropriate reading level including food-drug interaction information

drug education

Clinicians including dietitians should obtain a ____ drug and diet history including the use of"

full: OTC and dietary supplements and review potential drug-food interactions

A _____ should be developed for dealing with ______ for short and long term drug therapy

plan, potential drug-food interactions

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